Proximal Biceps Tendonitis

Kyle didn't pitch many innings in Little League and middle school. He mostly came in for short stints as a reliever. But in high school, the coach thought Kyle had a great arm and put him in the starting rotation. Soon Kyle was pitching more than ever before.

One day in the middle of the season, Kyle felt pain in his shoulder and upper arm after pitching a game. The next day it still hurt, so he told his coach. The coach took Kyle out of the rotation and recommended he see a doctor. The doctor examined Kyle's shoulder and said he probably had a case of proximal biceps tendonitis and would have to rest his arm for a few weeks.

What Is Biceps Tendonitis?

The biceps is the muscle in your upper arm that you flex when you bend your arm or show off your muscles. Tough connective tissues called tendons attach the biceps muscle to the elbow and shoulder and help you move your arm.

The tendon that attaches the lower part of the biceps to the elbow is the distal tendon. The tendons that attach the top of the biceps muscle to the shoulder are the proximal tendons.

There are two proximal tendons — the long head and the short head. They attach to your shoulder blade in different places to hold the top of your upper arm bone firmly in your shoulder socket while still allowing it to move.

If any of these tendons become swollen or irritated from overuse, it can lead to a condition called biceps tendonitis. If you have biceps tendonitis, it can hurt just to move your arm. The good news is, most cases heal on their own with rest and medication.

Signs of Proximal Biceps Tendonitis

Proximal biceps tendonitis usually starts out slowly and becomes more painful the more a person uses that arm. But sometimes an injury or small tear in the tendon can cause problems right away.

Some of the more common signs of proximal biceps tendonitis include:

pain in the front or side of the shoulder and the upper arm

pain in the arm at night, especially when you sleep on that side

pain when you move your arm, raise it above your head, or reach behind you

What Causes It?

The word "tendonitis" simply means that the tendon is irritated and swollen. In teens, biceps tendonitis is usually an overuse injury. Baseball pitchers, swimmers, tennis players, and people who have to reach above their heads a lot are at greater risk because of the repeated stress on their upper arms.

Proximal biceps tendonitis often happens along with other shoulder problems. In most cases, there is also damage to another shoulder tendon called a rotator cuff tendon.

How Do Doctors Diagnose It?

If your shoulder and upper arm hurt when you move your arm, and you're worried that you might have biceps tendonitis, call a doctor.

The doctor will examine you and ask about any activities you've been doing that might have caused the problem. He or she will also check the strength and range of motion in your shoulder and look to see if it feels loose or unstable. For more serious cases (or to rule out other problems), the doctor might want you to have an X-ray or magnetic resonance imaging (MRI) scan.

How Can I Prevent Biceps Tendonitis?

The best way to prevent biceps tendonitis is to avoid activities that put your arms above your head a lot. But if you swim or play tennis or baseball, that might not be an option!

If your activities put you at risk for biceps tendonitis, you'll want to do exercises that strengthen the muscles of your shoulder and upper arm. Strong muscles will keep the entire area more stable and less likely to get injured.

If you play a sport that puts you at greater risk of biceps tendonitis, make sure you know the right way to play. Playing in the wrong way can put your arm in weird positions that may put added stress on your shoulder. As much as you can, try to avoid reaching above your head or doing other things that require a lot of shoulder movement.

Most important, if you feel any pain in your shoulder or upper arm, stop doing the activity that might be causing it right away. Don't start the activity again until the pain is gone or a doctor has told you it's OK. Never try to ignore pain or play through it. This will most likely only make the condition worse.

How Should I Treat Biceps Tendonitis?

Most cases of biceps tendonitis can be treated at home with fairly simple methods. Although doctors sometimes need to do surgery to repair badly injured proximal biceps tendons, it's usually for adults. Kids and teens almost never need surgery for this kind of injury.

Treatment can include the following:

Rest your arm. Stop doing activities that require a lot of shoulder movement and try to avoid using your injured arm for any lifting or reaching.

Ice the affected area. Apply ice or a cold compress to your shoulder for up to 20 minutes several times a day to help keep the swelling down. (Never apply ice directly to the skin.)

Take anti-inflammatory medications. Painkillers such as ibuprofen can help relieve pain and reduce swelling in the shoulder and upper arm. The doctor also may recommend a cream or patch that can be applied to the skin. In some cases, doctors may give people steroid injections to ease pain and help reduce swelling.

Do stretching and strengthening exercises. These will help strengthen your shoulder and restore its range of motion. Strengthening and stretching exercises can help you recover and make you less likely to reinjure your arm. A doctor or a physical therapist can work with you to develop a good exercise program.

The good news about proximal biceps tendonitis is that most cases heal just fine on their own. But it does require patience. The key with this kind of injury is to give your arm plenty of time to rest. You don't want to jump back into your sport or activity too soon or you'll risk making things worse and spending even more time on the sidelines!